Surgical resection of metastatic pancreatic cancer: is it worth it?—a 15-year experience at a single Chinese center

Abstract

Background: The significance of surgical resection in the treatment of metastatic pancreatic ductal adenocarcinoma (PDAC) is currently unclear. This study aimed to summarize and clarify the experience of surgical treatment of M1 PDAC in our center and evaluate whether it may offer benefits to some metastatic PDAC patients.Methods: We analyzed the data of the patients with M1 PDAC who underwent synchronous tumor resection between 2003 and 2014 at Ruijin Hospital. Simultaneously, clinical data for M1 PDAC patients who underwent palliative bypass or exploratory laparotomy only was also collected during the same period as control. Every patient was followed up at least 3 years after hospitalization. The follow-up endpoint was December 31, 2017.Results: A total of 36 patients underwent synchronous tumor resection; of them, 7 received postoperative adjuvant chemotherapy. Their 1-, 2-, and 3-year survival rates were 27.3%, 21.2%, and 7.1%, respectively, and the overall survival was 7.9 months. The overall survival of the palliative bypass and exploratory laparotomy groups was only 4 and 3.7 months, respectively (P<0.05).Conclusions: It is unclear whether synchronous tumor resection can benefit M1 PDAC patients due to tumor heterogeneity and differences in tumor burden. However, our current experience indicated that synchronous tumor resection can be safely performed and might be appropriate for some highly selected patients due to the relatively longer survival time. Combined (neo)adjuvant chemotherapy would further prolong overall survival in these patients.

Worth it or not? Primary tumor resection for stage IV pancreatic cancer patients: A SEER‐based analysis of 15,836 cases

“…19,22 Gu et al compared patients that underwent PTR with those that underwent bypass or exploratory laparotomy only, on the basis of a 3-year follow-up. 14 They reported a significantly prolonged OS rate in patients that underwent PTR. However, the sample size was limited (34 for the PTR group), and adjuvant treatments were not well incorporated into the analysis.…”

Locoregional Treatment of Metastatic Pancreatic Cancer Utilizing Resection, Ablation and Embolization: A Systematic Review

“…Three articles were published that incorporated RFA in the treatment of mPDAC, all of which employed the technique for hepatic metastatic treatment ( Table 4 ) [ 38 , 39 , 40 ]. They included a total of 262 patients with liver mPDAC (108 synchronous, 154 metachronous disease), of whom 196 had their hepatic lesions treated with RFA and 66 received palliative chemotherapy, serving as controls [ 38 , 39 , 40 ]. Slightly improved survival (from metastatic diagnosis or treatment) was observed in mPDAC patients receiving primary resection and liver-directed RFA (12–14 months) and patients receiving liver-directed RFA only (11.4 months), compared to a matched chemotherapy control group with metachronous disease (9.1 months).…”

“…Those of clinical relevance included pleural effusions, liver abscesses and hemorrhages. All three articles reported prognostic factors ( Table 2 ), those offering a better survival outcome including fewer [ 40 ] and smaller liver lesions [ 38 , 39 , 40 ], well/moderate differentiation of the tumor, longer DFI [ 38 ] and a lower primary tumor stage [ 38 ].…”

“…Still, a similar concept could be applied for a trial including pulmonary mPDAC patients. As for the metastatic disease load, the number of lesions was a commonly noted prognostic factor [ 28 , 34 , 35 , 37 , 39 , 40 , 47 ]. We propose a cut-off of 5 lesions, with the explicit criterium that all lesions can be radically treated with locoregional therapy.…”

“…However, this is specifically the case for metachronous disease, as for synchronous disease intra-operative efforts must be made to attain this information. Other disease-related features reported as positive predictors of survival include a lower histological grade (well/moderately differentiated) [ 25 , 32 , 37 , 38 , 40 ] and lower (pre- and/or post-treatment) tumor marker CA19-9 serum levels [ 28 , 33 , 34 , 45 , 48 ]. These markers give an indication of disease progression and tumor aggressiveness, and thus impact prognosis.…”